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Hidden Meniscus Problems: Ramp Lesion and Posterior Meniscus Medial Root Tear

Ramp lesion (RL) is a peripheral tear affecting the posterior horn of the medial meniscus in the setting of ACL tears. Posterior meniscus medial root tear (PMMRT) is defined as an avulsion of the attachment, or a complete radial tear within 1 cm of the posterior tibial attachments of the meniscus. B...

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Autor principal: Butar Butar, John C. P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9983110/
http://dx.doi.org/10.1177/2325967121S00846
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author Butar Butar, John C. P.
author_facet Butar Butar, John C. P.
author_sort Butar Butar, John C. P.
collection PubMed
description Ramp lesion (RL) is a peripheral tear affecting the posterior horn of the medial meniscus in the setting of ACL tears. Posterior meniscus medial root tear (PMMRT) is defined as an avulsion of the attachment, or a complete radial tear within 1 cm of the posterior tibial attachments of the meniscus. Both are not uncommonly found. The prevalence of RL existing in conjunction with ACL tears ranges from 9 to 42%. On the other hand, PMMRT contributes up to 10 to 21% of all meniscus tears. Both RL and PMMRT have significant consequences. RT increases anterior tibia translation and internal rotation after ACL reconstruction which may increase graft failure. PMMRT may accelerate the progress of medial knee osteoarthritis. Unfortunately, both conditions are frequently overlooked from physical examination, MRI reading, and arthroscopy procedures, due to the low sensitivity, unfamiliarity, and hidden location of the lesions. Posteromedial tibia edema finding on MRI images in a complete ACL tear in young patients increases the risks of RL. Ghost sign and medial femorotibial edema found on MRI may indicate PMMRT. RL and PMMRT may not be identifiable from the standard arthroscopic view. The trochlear view may be needed for RL and MCL trephination is almost always needed for PMMRT. The stability of both lesions should be assessed by meniscus probing, and repair is the gold standard for unstable lesions. RL can be repaired with sutures from the anterior or posterior. PMMRT is usually repaired using the transtibial pull-out suture technique.
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spelling pubmed-99831102023-03-04 Hidden Meniscus Problems: Ramp Lesion and Posterior Meniscus Medial Root Tear Butar Butar, John C. P. Orthop J Sports Med Article Ramp lesion (RL) is a peripheral tear affecting the posterior horn of the medial meniscus in the setting of ACL tears. Posterior meniscus medial root tear (PMMRT) is defined as an avulsion of the attachment, or a complete radial tear within 1 cm of the posterior tibial attachments of the meniscus. Both are not uncommonly found. The prevalence of RL existing in conjunction with ACL tears ranges from 9 to 42%. On the other hand, PMMRT contributes up to 10 to 21% of all meniscus tears. Both RL and PMMRT have significant consequences. RT increases anterior tibia translation and internal rotation after ACL reconstruction which may increase graft failure. PMMRT may accelerate the progress of medial knee osteoarthritis. Unfortunately, both conditions are frequently overlooked from physical examination, MRI reading, and arthroscopy procedures, due to the low sensitivity, unfamiliarity, and hidden location of the lesions. Posteromedial tibia edema finding on MRI images in a complete ACL tear in young patients increases the risks of RL. Ghost sign and medial femorotibial edema found on MRI may indicate PMMRT. RL and PMMRT may not be identifiable from the standard arthroscopic view. The trochlear view may be needed for RL and MCL trephination is almost always needed for PMMRT. The stability of both lesions should be assessed by meniscus probing, and repair is the gold standard for unstable lesions. RL can be repaired with sutures from the anterior or posterior. PMMRT is usually repaired using the transtibial pull-out suture technique. SAGE Publications 2023-02-28 /pmc/articles/PMC9983110/ http://dx.doi.org/10.1177/2325967121S00846 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by-nc-nd/4.0/This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For article reuse guidelines, please visit SAGE’s website at http://www.sagepub.com/journals-permissions.
spellingShingle Article
Butar Butar, John C. P.
Hidden Meniscus Problems: Ramp Lesion and Posterior Meniscus Medial Root Tear
title Hidden Meniscus Problems: Ramp Lesion and Posterior Meniscus Medial Root Tear
title_full Hidden Meniscus Problems: Ramp Lesion and Posterior Meniscus Medial Root Tear
title_fullStr Hidden Meniscus Problems: Ramp Lesion and Posterior Meniscus Medial Root Tear
title_full_unstemmed Hidden Meniscus Problems: Ramp Lesion and Posterior Meniscus Medial Root Tear
title_short Hidden Meniscus Problems: Ramp Lesion and Posterior Meniscus Medial Root Tear
title_sort hidden meniscus problems: ramp lesion and posterior meniscus medial root tear
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9983110/
http://dx.doi.org/10.1177/2325967121S00846
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